This form is used to request a copy of a paycheck stub, direct deposit advice or record of
earnings.

Complete the following:

Name

Employee #

Birthdate

Department

Phone

Email

Confirm Email

I would like to request the following:

Record of Earnings
Pay Check Stub
Direct
Deposit Advice

Enter payday or year needed in the box below:

Please send the records requested to:

Permanent address of record
Campus address of record
Don't mail it, I will pick
it up* and show ID
Mail to
this campus address:
Mail
to this off campus address:
Fax to:

Comments:

*Note: Records requested can be picked up at the Payroll Services window at
10920 Wilshire Blvd, Suite 620. Requests for
records will take about a week to process.
We will call you when the records are ready for pick up at the Payroll Services
window.

Once you click on the Send Email form button below, a confirmation form will
appear. We suggest that you print it for your records. If you do not see a
confirmation form in your web browser or receive an error message, please call (310)
825-1089 to request the records by phone.